THE CIVIL REGISTRATION SYSTEM IN GHANA/COORDINATION AMONG THE REGISTRATION, STATISTICS AND HEALTH SECTORS

Presented byKingsley Asare AddoPrincipal Assistant RegistrarGhana

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Background to vital registration in Ghana

1888-Vital registration started in in the Gold Coast (now Ghana) - regulated by Cemeteries Ordinance1912-Births, Deaths and Burials Ordinance enacted to replace law of 1888- birth registration introduced1965- Registration of Births and Deaths Act passed to:

-Ensure compulsory and universal registration of births/deaths in Ghana

-Promote public health in the country.-Establish an efficient system of births and deaths registration

records for the citizenry -Obtain vital statistics data which are adequate and efficient

enough for deriving reliable demographic estimates to support public health planning, for policy formulation at various levels of governance and for development planning in the country

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Birth Registration Process

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Live Births occurring in Hospitals/Health Facilities

Public HospitalsPrivate Hospitals Medical Certification ( Road to Health Card)Clinics (Doctor/Midwife/ Child Welfare Clinic) Maternity Homes

PARENTS/ RELATIVE

BIRTHS AND DEATHS REGISTRY GHANA STATISTICAL SERVICE(Birth Certificate)

Live Births Occurring outside Health Facilities

Home CHNTBA PARENT/RELATIVE Others CV

Abandoned Children PoliceSocial Welfare Children’s Home

Death Registration Process

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Deaths occurring in Hospitals /Health facilities

Public HospitalsPrivate Hospitals Medical Certification (Medical Certificate of Cause of Death)Clinics (Doctor)

RELATIVE Cemetery(Burial Permit)

BIRTHS AND DEATHS REGISTRY Ghana Statistical Service

Deaths occurring outside health facilitiesHome

Police Coroner RELATIVE (Coroner’s Inquest Report)

Others

CommunityVolunteer

Cemetery

Operational Structure5

registryReporting

centreregistry

The Staff Situation

REGION POPULATION (2000 POPN. CENSUS)

NO. OF REGISTRIES

NO OF STAFF ADDITIONAL STAFF REQUIRED

NO. OF VEHICLES

ALL REGIONS 18,912,079 397 339 3782 7

H/ OFFICE 0 0 43 - 3

WESTERN 1,924,577 34 30 385 1

CENTRAL 1,593,823 45 37 319 1

GT. ACCRA 2,905,726 54 62 421 1

EASTERN 2,106,696 53 40 421 0

VOLTA 1,635,421 49 24 327 0

ASHANTI 3,612,950 53 35 723 1

B/AHAFO 1,815,408 40 22 363 0

NORTHERN 1,820,806 30 14 364 0

U/EAST 920,089 18 12 184 0

U/WEST 576,583 21 20 115 06

Partnerships and linkages

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BIRTHS AND DEATHS

REGISTRY

Hospitals, clinics

CHPS, CHN, DSS

(Community Events)

Volunteer, TBA, Chiefs

STATISTICAL SERVICE

Police, Coroner Social

Welfare

District level planning

Regional Level planning

National Level planning

National identification

Education, passport, social

securityEmployment,

electoral commission

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Registered births (0-12 months only) 2000-2008

REGION POPULATIO

N EXPECTED BIRTHS REGISTERED BIRTHS % COVERED

2000 18,912,079 756,483 236,335 31

2001 19,422,705 776,908 211,081 27

2002 19,947,118 797,885 138,151 17

2003 20,485,690 819,428 239,919 29

2004 21,038,804 841,552 430,127 51

2005 21,606,852 713,026 476,251 67

2006 22,190,237 732,278 391,841 54

2007 22,789,373 752,049 466,129 62

ALL REGIONS

2008 23,404,686 772,355 392,898 51

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Coverage and completeness of system

10Ghana’s popn. 2000 census = 18,912,029Total popn with registration facilities= 4,609,523Coverage of registration = 25%Completeness of registrationYear Birth(%) Death(%)2000 31 202001 27 222002 17 Average 21 Average 2003 29 23 2004 51 49% 24 25%2005 67 242006 54 232007 62 242008 51 22

Registered deaths (within 12 months of occurrence only) 2000-2008

REGION POPULATION EXPECTED DEATHS REGISTERED DEATHS % COVERED

2000 18,912,079 226,945 45,402 20

2001 19,422,705 233,072 51,639 22

2002 19,947,118 239,365 49,530 21

2003 20,485,690 204,857 47,492 23

2004 21,038,804 210,338 50,625 24

2005 21,606,852 216,069 52,079 24

2006 22,190,237 221,902 51,841 23

2007 22,789,373 227,894 54,234 24

ALL REGIONS

2008 23,404,686 234,047 52,382 22

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Challenges13

Major challenges include: Low utilization of vital statistics for policy decisionsLimited Access to registration facilitiesLow public knowledge about importance of registration Inadequate staffInability to attract and retain highly qualified personnel due to low remuneration and poor service conditionsInadequate funding for the Registry,Difficulty in motivating registration volunteersLack of logistics including accommodation, vehicles, requisite statistical software and programmes.Absence of training opportunities for sector staffWeak monitoring and supervision mechanisms.

Strategies to improve coverage14

BUILDING PARTNERSHIPSCollaboration with Ghana Health Service-

participation in Child Health Promotion Campaign, Integrated Maternal and child health

programmes, May & Nov. Every year

- -Trained Community Health Workers (1,000) & Community Volunteers (1,250)to collect info. on vital events

- - Collaboration with Ghana Statistical Service, District Assemblies & Plan Ghana to pilot a Community Population Register Programme in 4 regions

Strategies to improve coverage cont’d

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AWARENESS CREATION- Public education initiated-use of

radio, TV & press- Community Durbars- Mobile registration-UBR Campaign- led by

“Goodwill Ambassador” for birth registration

- “Births and Deaths Registration Day”celebration instituted in Ghana – 1st

September every year since 2004

Improving quality of data16

Computerising data storage, management, analysis & retrievalEarly registration of vital events- community based operatives get first hand information of vital eventsCapacity building for Registration staff- training in statistical data analysis, management and reportingDevelopment and use of Standard operating procedures country wideReviewed data capture documents to conform with international standards

Form Processing Environment

Way Forward18

Make registration facilities accessible to rural populations by expanding community population register programme to cover more rural communities in GhanaStep up and sustain public education on importance and benefits of vital registration Strengthen collaboration with all stakeholders to achieve universal registrationTraining and scaling up of verbal autopsy nation-wide

Way Forward cont’d19

Pursue total computerisation of programme – link all regional offices to Central office through WAN in the short term and in the long term all district registration offices.Capture backlog of data stock- 1912 to 2008 Interface with stakeholders-

Ghana Health ServiceGhana Statistical ServiceMinistry Of Health,National Identification AuthorityElectoral CommissionGhana Immigration ServiceSSNIT, DVLA, etc

Making vital registration relevant

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Ghana will seek to improve on its vital registration system by:

a) Increasing coverage of the registration machinery ( operationalising population registers in all communities) especially in rural areas

b) Fine-tuning data capture, processing, management, storage & retrieval

c) Make vital registration data available for use by health institutions, researchers, policy makers, development planners.

THANK YOU!21

Clips from BDR day Celebration 2007

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